A 24-year-old man presents to the medical team after experiencing an allergic reaction during a contrast-enhanced MRI of the small bowel. He reports feeling his throat closing up and becoming anxious shortly after receiving an IV injection of the contrast agent. The emergency team notes tachycardia and hypotension, as well as a widespread rash and itching. The patient is treated for anaphylactic shock.
What blood tests can be done to confirm the diagnosis of anaphylaxis?
A 60-year-old male is admitted after being found collapsed in the city center by the police. He is known to be an alcoholic and appears disheveled and unclean. Upon examination, he is confused with a Glasgow coma scale of 13, a temperature of 37°C, a regular pulse of 110 bpm, and a blood pressure of 138/96 mmHg with oxygen saturations of 98%. There are no specific abnormalities on examination, with normal reflexes, tone, and down going plantars. He has a respiratory rate of 30 per minute.
The following investigations were conducted:
– Haemoglobin: 115 g/L (130-180)
– MCV: 102 fL (80-96)
– White cell count: 8.2 ×109/L (4-11)
– Platelets: 150 ×109/L (150-400)
– Serum sodium: 136 mmol/L (137-144)
– Serum potassium: 3.6 mmol/L (3.5-4.9)
– Serum urea: 7.0 mmol/L (2.5-7.5)
– Serum creatinine: 120 µmol/L (60-110)
– Plasma glucose: 5.2 mmol/L (3.0-6.0)
– Arterial blood gas analysis:
– pH: 7.24 (7.36-7.44)
– pO2: 14.7 kPa / 110 mmHg (11.3-12.6)
– pCO2: 4.0 kPa / 30 mmHg (4.7-6.0)
– Standard HCO3: 17 mmol/L (20-28)
Which investigation is most likely to aid in the diagnosis?
A 57-year-old male presents with a two-month history of palpitations, excessive sweating, and weight loss. He was diagnosed with atrial fibrillation two years ago and has been taking amiodarone. On examination, his pulse rate is irregularly irregular at 80 beats per minute, and his blood pressure is 135/80. There are no signs of goitre, eye or hand signs.
The following investigations were conducted:
– Serum free T4: 60 pmol/l
– Serum free T3: 15 pmol/l (5-10)
– Serum TSH: <0.05 mU/l
– Serum antithyroid peroxidase: negative
– TSH receptor antibodies: negative
– Radioactive iodine uptake scan: reduced uptake by the thyroid gland
What is the most appropriate management for this patient?
An 80-year-old man presents to the emergency department with shortness of breath. A CT pulmonary angiogram reveals a segmental pulmonary embolus with mild right heart strain. The patient has a history of chronic kidney disease stage IV due to type 2 diabetes and hypertension. Intravenous unfractionated heparin is initiated, but routine blood tests reveal a new abnormality in full blood count and positive heparin induced thrombocytopenia antibodies. What is the appropriate management for the patient’s thrombocytopenia after cessation of IV heparin infusion?
A 23-year-old man presents to the emergency department with his girlfriend after collapsing at a party at 3:00am. It is now 5:00am. During the examination, he is unresponsive to verbal stimuli and has dry mucous membranes. He has flushed skin and feels very warm to the touch. There is mildly increased muscle tone, myoclonic jerks, and hyperreflexia globally but worse in the lower limbs. Pupils are dilated but respond to light equally and bilaterally. He is disorientated and agitated, thrashing about in the bed and occasionally lashing out at people.
His vital signs are heart rate 126/min, blood pressure 90/60 mmHg, respiratory rate 18/min, temperature = 40.3ºC, and sats 97% on 10l of oxygen. His laboratory results show Na+ 136 mmol/l, K+ 3.9 mmol/l, urea 2.3 mmol/l, creatinine 77 µmol/l, glucose 4.6 mmol/l, and creatinine kinase 12,000 U/l. His bilirubin is 25 µmol/l, ALP 185 u/l, ALT 125 u/l, γGT 144 u/l, and albumin 40 g/l.
A CT scan of his head shows no abnormalities, and a lumbar puncture reveals an opening pressure of 15 cm CSF, clear appearance, glucose 3.5 mmol/l, protein 0.3 g/l, and white cells 4 / mm³. He has a past medical history of schizoaffective disorder and is taking Olanzapine 15 mg and Sertraline 150mg regularly. His girlfriend tells you that he took an unknown white powder while at the party.
What is the most appropriate treatment plan?
A 50-year-old woman presents to the emergency department with shortness of breath. She has no significant past medical history and does not have any regular medications. She smokes ten cigarettes daily and lives alone.
Her observations are heart rate 110 beats per minute, blood pressure 120/88 mmHg, respiratory rate 18/minute, oxygen saturations 97% on 4L of oxygen and temperature 37ºC.
Clinical examination is unremarkable.
Blood tests:
Hb 138 g/L Male: (135-180)
Female: (115 – 160)
Platelets 180 * 109/L (150 – 400)
WBC 5.2 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 4.2 mmol/L (2.0 – 7.0)
Creatinine 88 µmol/L (55 – 120)
CRP 4 mg/L (< 5)
D-dimer 2000 ng/mL (<250)
Trop 8 ng/L (<15)
A chest x-ray is normal.
A CTPA demonstrates a large saddle embolus. There is no CT or echocardiographic evidence of right heart strain.
She is commenced on a heparin infusion. She successfully manages to wean oxygen by day 5 of treatment and has some repeat blood tests prior to a switch to an oral anticoagulant.
Blood tests:
Hb 136 g/L Male: (135-180)
Female: (115 – 160)
Platelets 32 * 109/L (150 – 400)
WBC 4.6 * 109/L (4.0 – 11.0)
What is the most appropriate medication to switch to from the heparin infusion, given the likely diagnosis?
A 62-year-old man is being seen in the medical follow-up clinic. He underwent a renal transplant 6 months ago due to end-stage kidney disease. He reports feeling self-conscious when he laughs because his gums have become very prominent. His medical history includes long-standing hypertension, and he is currently taking only ciclosporin. On examination, his blood pressure is 140/80 mmHg, BMI is 27 kg/m2, gums are swollen, chest is clear, and the renal transplant is non-tender. What other potential complications of ciclosporin treatment should this patient be aware of?
A 16-year-old girl arrives at the emergency department accompanied by her father. She is experiencing drowsiness, ataxia, vomiting, her heart rate is 130 beats per minute and her blood pressure is 130/84 mmHg. She has a history of epilepsy which has been under control lately. She ingested an unknown amount of sodium valproate after having an argument with her boyfriend 30 minutes ago.
What intervention would you initiate after administering initial fluid resuscitation?
You assess a 59-year-old man with severe hypertension who has come to the Emergency Department complaining of intractable headache, diplopia, nausea and vomiting. His BP is 195/115 mmHg and he has papilloedema, diplopia, nausea and vomiting. You initiate a labetalol infusion but his hypertension persists. You contemplate administering a sodium nitroprusside infusion. What is the most appropriate action to take?
A 29-year-old woman arrives at the emergency department complaining of a persistent headache that has been worsening over the past four days, particularly when lying down. She also reports experiencing blurred vision since yesterday. Her medical history includes chronic back pain, acne, and anxiety. During the examination, it is noted that she is overweight and fundoscopy reveals papilloedema. After further investigations, she is diagnosed with idiopathic intracranial hypertension. Which medication that she is taking is linked to this condition?